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58 Approach to Radiographic Changes Observed in a Specif ic Joint
FIGURE 2-40. Erosive osteoarthritis.
Soft tissue change: Swelling at the third and fourth PIPs
Subluxations: Laterally at third and fourth PIPs
Mineralization: Normal
Calcification: None
Joint spaces: Nonuniform loss—best seen at third PIP and first IP
Erosions: Central erosions—combined with osteophytes to produce “seagull” appearance
Bone production: Osteophytes at PIPs, DIPs, first carpometacarpal joint and greater multangular-navicular joint; subchondral sclerosis at second to fourth DIPs, PIPs and IP joint of thumb; ankylosis fifth DIP
Distribution: PIPs and DIP; first carpometacarpal and greater multangular-navicular joint
58 Approach to Radiographic Changes Observed in a Specif ic Joint
FIGURE 2-40. Erosive osteoarthritis.
Soft tissue change: Swelling at the third and fourth PIPs
Subluxations: Laterally at third and fourth PIPs
Mineralization: Normal
Calcification: None
Joint spaces: Nonuniform loss—best seen at third PIP and first IP
Erosions: Central erosions—combined with osteophytes to produce “seagull” appearance
Bone production: Osteophytes at PIPs, DIPs, first carpometacarpal joint and greater multangular-navicular joint; subchondral sclerosis at second to fourth DIPs, PIPs and IP joint of thumb; ankylosis fifth DIP
Distribution: PIPs and DIP; first carpometacarpal and greater multangular-navicular joint
Erosive OA
Evaluation of the Hand Film 59
FIGURE 2-41. CPPD crystal deposition disease.
Soft tissue change: None
Subluxations: None
Mineralization: Normal
Calcification: Triangular cartilage (fibrous cartilage); between lunate and triquetrum (hyaline cartilage) (arrows)
Joint spaces: Uniform loss of second through fourth MCPs, radiocarpal, and capitate-lunate
Erosions: None
Bone production: Osteophytes at MCP joints; subchondral sclerosis in navicular, capitate, lunate
Distribution: MCPs, 1st metacarpal-carpal joint, radionavicular joint, and capitate-lunate joints
Evaluation of the Hand Film 59
FIGURE 2-41. CPPD crystal deposition disease.
Soft tissue change: None
Subluxations: None
Mineralization: Normal
Calcification: Triangular cartilage (fibrous cartilage); between lunate and triquetrum (hyaline cartilage) (arrows)
Joint spaces: Uniform loss of second through fourth MCPs, radiocarpal, and capitate-lunate
Erosions: None
Bone production: Osteophytes at MCP joints; subchondral sclerosis in navicular, capitate, lunate
Distribution: MCPs, 1st metacarpal-carpal joint, radionavicular joint, and capitate-lunate joints
Evaluation of the Hand Film 59
FIGURE 2-41. CPPD crystal deposition disease.
Soft tissue change: None
Subluxations: None
Mineralization: Normal
Calcification: Triangular cartilage (fibrous cartilage); between lunate and triquetrum (hyaline cartilage) (arrows)
Joint spaces: Uniform loss of second through fourth MCPs, radiocarpal, and capitate-lunate
Erosions: None
Bone production: Osteophytes at MCP joints; subchondral sclerosis in navicular, capitate, lunate
Distribution: MCPs, 1st metacarpal-carpal joint, radionavicular joint, and capitate-lunate joints
CPPD Crystal Deposition Disease
60 Approach to Radiographic Changes Observed in a Specif ic Joint
FIGURE 2-42. Gout.
Soft tissue change:
Soft tissue mass around second and fifth DIP, ulnar styloid
Subluxations: Laterally at thumb IP joint
Mineralization: Normal
Calcification: In soft tissue masses—best seen at ulnar styloid
Joint spaces: Maintained; loss at second through fifth MCPs, PIPs; nonuniform loss at first IP; destruction of 2nd and 5th DIPs
Erosions: Nonaggressive; second and fifth DIP, second PIP (arrow), third and fourth intercarpal joint, scaph-olunate joint, ulnar styloid
Bone production:
Overhanging edge of cortex—second and fifth DIP joint
Distribution: Carpometacarpal and scapholunate joint; ran-domly throughout fingers—second and fifth DIPs
60 Approach to Radiographic Changes Observed in a Specif ic Joint
FIGURE 2-42. Gout.
Soft tissue change:
Soft tissue mass around second and fifth DIP, ulnar styloid
Subluxations: Laterally at thumb IP joint
Mineralization: Normal
Calcification: In soft tissue masses—best seen at ulnar styloid
Joint spaces: Maintained; loss at second through fifth MCPs, PIPs; nonuniform loss at first IP; destruction of 2nd and 5th DIPs
Erosions: Nonaggressive; second and fifth DIP, second PIP (arrow), third and fourth intercarpal joint, scaph-olunate joint, ulnar styloid
Bone production:
Overhanging edge of cortex—second and fifth DIP joint
Distribution: Carpometacarpal and scapholunate joint; ran-domly throughout fingers—second and fifth DIPs
60 Approach to Radiographic Changes Observed in a Specif ic Joint
FIGURE 2-42. Gout.
Soft tissue change:
Soft tissue mass around second and fifth DIP, ulnar styloid
Subluxations: Laterally at thumb IP joint
Mineralization: Normal
Calcification: In soft tissue masses—best seen at ulnar styloid
Joint spaces: Maintained; loss at second through fifth MCPs, PIPs; nonuniform loss at first IP; destruction of 2nd and 5th DIPs
Erosions: Nonaggressive; second and fifth DIP, second PIP (arrow), third and fourth intercarpal joint, scaph-olunate joint, ulnar styloid
Bone production:
Overhanging edge of cortex—second and fifth DIP joint
Distribution: Carpometacarpal and scapholunate joint; ran-domly throughout fingers—second and fifth DIPs
Gout
RA
RA
Psoriasis
Gout
Psoriasis
RA with OA - look for the uniformity - Never in degenerative
CPPD
Sarcoidosis
Carpal Compartment Evaluation of the Hand Film 51
FIGURE 2-31. Normal wrist with outline of the different compartments: (1) the radiocarpal compartment, (2) the midcarpal compartment, (3) the common carpometa-carpal compartment, and (4) the first carpometacarpal compartment. (From Brower AC: The radiologic approach to arthritis, Med Clin North Am 68:1593, 1984; reprinted by permission.)
FIGURE 2-32. Pancarpal loss of joint spaces in a patient with rheumatoid arthritis.
(1) radiocarpal compartment (2) midcarpal compartment (3) common carpometacarpal compartment (4) first carpometacarpal compartment
All compartments – inflammatory arthritides first carpometacarpal joint – OA and erosive OA CPPD - radiocarpal compartment à extends in stairstep pattern à the capitate-lunate joint Gout - predilection for carpometacarpal compartment
References
ò Jacobson JA, Girish G, Jiang Y, Resnick D. Radiographic evaluation of arthritis: inflammatory conditions. Radiology. 2008;248(2):378-89
ò Jacobson JA, Girish G, Jiang Y, Sabb BJ. Radiographic evaluation of arthritis: degenerative joint disease and variations. Radiology. 2008;248(3):737-47
ò Brower, Anne C., et al. Arthritis in Black and White. Elsevier Saunders, 2012
ò Greenspan, Adam. Orthopedic Imaging: a Practical Approach. Wolters Kluwer/Lippincott, Williams & Wilkins, 2011
